Revolutionary Treatments

Newer treatments for two common chronic skin diseases—psoriasis and eczema—have revolutionized the way doctors are now treating the diseases, says Dr. Christina Alexander.

“Psoriasis is a really common chronic inflammatory skin disease,” says Alexander, a dermatologist at St. Elizabeth Dermatology Crestview Hills at 651 Centre View Blvd. “I would say it’s one of the more common things I see in clinics.”

Some of the newer therapies to treat psoriasis are called biologics, she says. The biologic drugs, a protein-based medicines manufactured from cell culture, are administered by a shot or intravenous infusion.

The biologic drugs target and block different inflammatory mediators and pathways that lead to psoriasis, Alexander says. “These newer ones actually are sometimes able to clear a patient’s skin disease,” she says.

The drugs that have been around the longest are known as tumor necrosis factor-alpha (TNF) inhibitors, Alexander says. In terms of risk, the major issue doctors worry about with these TNF inhibitor drugs is infection, she says. “But in general people tolerate them well.”

People with psoriasis, especially if they have more extensive skin disease, can also be at higher risk of having cardiovascular disease, says Alexander. Studies have shown that it’s possible to decrease the cardiovascular risk with the TNF inhibitor therapy, she says.

Newer biologic therapies to treat psoriasis target different molecules in the inflammatory pathway, Alexander says. “So, for example, there’s a few that target something called (interleukin)-17,” she says.

Other psoriasis drugs target another molecule called (interleukin)-23, says Alexander. “They target different things but they’ve been shown to work really well,” she says. “It’s blocking the inflammation that causes the skin disease.”

For those who might not be thrilled with the idea of receiving a shot for their psoriasis treatment, Alexander says there is also a pill that has recently been approved to treat psoriasis called Otezla.

Although it doesn’t work as well as the injection medicines or the biologic therapies, first-time patients have seen good results, she says. More importantly, the pill doesn’t increase the risk of infection, says Alexander. “So it’s a good option in that way.”

Eczema, another type of chronic inflammatory skin rash, is typically treated initially with gentle skin care and then topical steroids, she says. Additional therapies would include light treatment or a pill called methotrexate, says Alexander.

More recently there’s been an injection medicine that’s been approved for eczema called Dupixent, she says. “It works really well,” Alexander says. “I’ve had several patients that I’ve treated with it and it’s cleared their skin disease so it just makes their lives a lot better.”

None of the new treatments for psoriasis or eczema can cure patients of the disease, only clear a patient’s skin. “If they were to come off of the medicine then, unfortunately, probably their rash is going to come back,” she says. “But usually what we do is keep them on it to keep them controlled.”